Litigation and Enforcement Actions against Providers: Lessons learned from recent cases!

Thomas J. Force, Esq.

Thomas J. Force, Esq.

As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance...
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60 Mins
Thomas J. Force, Esq.

This webinar by healthcare attorney, Thomas J. Force, Esq., reviews recent cases and enforcement actions that highlight the pitfalls, proper procedures, and possible defenses related to allegations of Stark Law, Anti-Kickback Statute, False Claims Act, Fee Forgiveness, and/or improper financial hardship cost-share waiver violations. Concerning these legal/regulatory areas, providers and facilities are often unintentionally blinded by the promise of monetary upside, leaving providers and facilities inadvertently at considerable risk.

During the webinar Thomas will review and demonstrate, how even the most innocent relationships or well-meaning providers can find themselves in serious “hot water” that can lead to substantial financial liability, loss of licensure, or, worse, prison time. These relationships can include those with hospitals, other providers, DME companies, technology platforms, or even patients themselves.

In addition,Thomas will help you gain a clearer understanding as to how such allegations arise, how whistle-blowers are often highly-incentivized to report any conduct that may not be above board, even where no ill intentions exists (e.g., you’ll learn that one whistle blower received $12 million dollars for reporting violations!), how several government and/or regulatory agencies may combine and conduct investigations for years (demonstrating the seriousness of these allegations, and how even services that are simply deemed medically unnecessary can result in liability.

Concerning fee forgiveness, through the use of case review, this webinar will demonstrate the importance of documentation concerning the granting of hardship waivers (as well as tips for a more compliant process), how the carriers’ SIU departments bolster their case against a provider allegedly engaged in fee forgiveness, the financial ramifications of fee forgiveness allegations, as well as defenses providers regularly believe (albeit, sometimes incorrectly) to be applicable.

At the conclusion of this program, there will be an opportunity to have your questions answered by Mr. Force, helping to guaranty that you get substantial value from virtually attending this program.

Webinar Objectives

The objective of this session is to provide insight into how practice protocols, procedures, and relationships can often run afoul of legal and regulatory requirements, and, thus, require significant scrutiny and careful consideration before such policies and relationships are established.

By reviewing cases and enforcement actions, a clearer picture can be drawn showing how even policies or relationships that appear to be minor or routine in nature can lead to financial or professional ruin. 

Webinar Agenda

  • Overview of Stark Law, Anti-Kickback Statute (AKS), False Claims Act, and fee forgiveness allegations.
  • Review of cases and enforcement actions related to Stark Law and AKS
  • Review of cases and enforcement actions related to the False Claims Act, including billing for services that were not rendered or medically necessary.
  • Review of cases related to fee forgiveness, including as related to the improper granting of financial hardship cost-share waivers.
  • Overview of what these cases teach us, best policies/practices to implement, and possible defenses that can be relied upon.
  • Questions & answers

Webinar Highlights

  • What Stark Law and AKS cover, as well as the penalties/consequences for violations
  • What the False Claims Act covers, as well as the penalties/consequences for violations
  • What constitutes fee forgiveness and the possible ramifications for carriers believing a provider is engaged in the same
  • How to properly document financial hardship waivers
  • Possible defenses to fee forgiveness allegations, including potential counter claims

Who Should Attend

Healthcare Providers and Facilities, Including Ownership, Management, and Billing Staff.

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